title: Paracorporeal ventricular assist device as a bridge to transplant candidacy in the era of implantable continuous-flow ventricular assist device.
abstract: Ventricular assist devices (VADs) have long been used as bridge to transplant therapy (BTT). Nipro-Toyobo paracorporeal pulsatile-flow VAD (nt-VAD) was the only device available until April 2011, when implantable continuous-flow VADs (cf-VADs) became available. Although cf-VADs are central to BTT, nt-VAD remains a necessary option. We aimed to clarify the role of nt-VAD in an era of increasing cf-VAD use. We retrospectively reviewed patients who underwent VAD implantation at the National Cerebral and Cardiovascular Center from May 2011 to March 2013. Characteristics were compared between the nt-VAD and cf-VAD groups. Twenty-nine patients (mean age 37.7 ± 11.1 years, 23 males) underwent VAD implantation. Fifteen patients initially received nt-VADs, although 4 were converted to cf-VADs. Of these 15 patients, 3 were too small for cf-VADs and 2 needed bilateral ventricular support. The remaining 10 patients received nt-VADs (7 patients at INTERMACS level 1 and 3 at level 2). The nt-VAD group patients had significantly more preoperative mechanical circulatory support and were in a more critical condition before VAD implantation than the cf-VAD group. The 2-year survival rate was not significantly different. Despite the critical conditions of nt-VAD patients, their overall survival is not statistically inferior to that of cf-VAD patients. nt-VAD is a good option as a BTC for the patient with urgent and critical condition.
authors.affiliation: Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka, 565-8565, Japan, suwa.hideaki.hp@mail.ncvc.go.jp.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Suwa
authors.forename: Osamu
authors.initials: O
authors.lastname: Seguchi
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Fujita
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Murata
authors.forename: Michinari
authors.initials: M
authors.lastname: Hieda
authors.forename: Takuya
authors.initials: T
authors.lastname: Watanabe
authors.forename: Takuma
authors.initials: T
authors.lastname: Sato
authors.forename: Haruki
authors.initials: H
authors.lastname: Sunami
authors.forename: Masanobu
authors.initials: M
authors.lastname: Yanase
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hata
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakatani
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000401:mortality / Q000601:surgery*; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000706:statistics & numerical data*; D012189:Retrospective Studies